Epilogue: FAQs

Yes, "MOM.D. - At Last" is, at last, done.  However, I thought I'd write one last morsel to answer, what are I'm sure, your burning questions.

Was there not a residency graduation ceremony?

After donning a cap and gown three or four (if you count kindergarten) times, there was no traditional graduation ceremony for residency.  There was a cocktail reception for all the graduating family medicine residents in Omaha, but I didn't feel the need to drive back for that.  I don't think I missed much.  People are also surprised to hear that once all of the paperwork was done I received a lowly email (with the sender being "help@theabfm.org" right after the spam from Kohl's and right before my "Your Order has Shipped" notice) proclaiming that I was board certified:

Susan M Newman 4129 Cannon RD Grand Island, NE 68803

Dear Doctor Newman:

Congratulations! We are pleased to inform you that you have successfully completed the necessary requirements for recognition as a Diplomate of the American Board of Family Medicine. You may obtain an official copy of your certification verification letter within your physician portfolio at www.theabfm.org.

... blah, blah, blah ...

Our best wishes for your continued success.

Most sincerely,

James C Puffer, M.D.

President and Chief Executive Officer

How did I celebrate retiring from my career as a student?

I took two weeks off.  Naturally, your next question will be: what did you do with your two weeks?  Intentionally, I didn't plan much.  A year or so ago, we thought we'd go on a cruise or some relaxing vacay.  Then we went through FPU and that chunk of change ended up going to the student loan black hole.  I also didn't want to feel like I needed a vacation from my vacation right before I started my job, and there will plenty of time in the future that I'll need to "get away."  Instead, my plan has been to lay around, hang out with my boys, and do some fun work around the new house.

What was my favorite memory?

I know it's boring, but the truth is that I don't have "a" favorite.  There have been so many memorable moments, and some of the most memorable are not warm and fuzzy or hilariously funny.  Do I choose between exposed brain; weird places I've had to pump (not gas); good, bad, or sad baby deliveries; nice thing patients have said; or on call stories?

If I had residency to do over again, what would I do differently?

As I've been approaching the end there have been several times when I wished I could go back and just do it all again.  Not because I want to endure the long hours or humbling moments again, but I feel like I would get so much more out of anatomy, lectures, clerkships, rotations, patient encounters, calls, shelf/step/board exam studying, and "you-have-to-come-see-this" moments if I knew then what I know now.  Go through it this time without the anxiety/pride-motivated goal of "just pass" or "next month will be better."  I guess that's just the life lesson from here on out.

Will I see friends or family as patients?

The short answer is - Yes.  There are some laws that say that I can't treat my immediate family or myself, but beyond the five of us it's pretty gray.  I've always wanted to practice in a smaller town because I don't mind, and kind of enjoy, running into patients in the grocery store.  (It keeps me honest in what I'm putting in my cart at the same time that I'm peeking what's in theirs.)  My standard line is: "I'm happy to see you as long as it won't be weird for you.  I'll treat you like, and tell you what I'd tell, any other patient.  And, I really do value what 'confidential' means."

Are we done having kids?

I really think so.  My boys are awesome!  I love them to pieces.  They don't come any better.  I've really enjoyed every moment with each of them from positive pregnancy test to now as Griffin is kicking the wall.  Still, I think I'll have enough of my fill of pregnancy-torn body, baby-bobble head, diapers, and terrible two's by the time they all hit school-age.  Nothing has been made permanent yet, but I really do feel complete.  We might get a dog though.

Will I still blog?

This is probably the most often asked and the most difficult to answer.  I think "MOM.D." is done.  I'm less confident about that answer than I am about being done with child-bearing, but I do think my blogging days are behind me.  If nothing else, I'm at least going to take an extended break and regroup.  This seems like a good and natural time to wrap it up.  I'd hate to pull a Brett Favre and miss my chance to go out on top and instead stoop to some low level like having an uninteresting, unread blog or becoming a Minnesota Viking.  It has been a ton of fun and really therapeutic, and I do have a passion for writing.  It's one of those things that I enjoy, feel comes naturally, and maybe is my calling.  Therefore, while I may be done blogging, I'm definitely not done writing.  I just haven't quite figured out the next avenue.  Maybe a book?

Thanks for reading!

Susan

101 Ways to Kill a Resident's Pager

In honor of Susan ending her residency and as husband of said "former" resident I felt the need to hijack her blog one last time.  This is one topic I have been pondering since last March.

I believe I speak for all doctor and resident spouses when I say I hate pagers.  I mean, seriously, the only people who carry pagers are drug dealers and doctors.  I feel like the 1% of society who has actually heard a beeper "page" sound and the .5% of the population that has heard that sound at 3AM when I need to wake up in two and a half hours.  I will never escape the sound of a drunk woman (who truly sounds like a man) asking for pain killers but I will be set free from the chains resident pager!

So in honor of the worst, most outdated device that is still used in 2013 I have devised 101 ways to kill a resident's pager.  You may think less of me, then again you most likely haven't had it wake up you up in the middle of the night for people calling about chapped lips, butt soreness, slight fevers, toe pain, and other things that can't mentioned a blog young eyes may see.

1) Smash it with a hammer (I've had dreams about this one).

2) Strap it to an M-80.

3) Pager skeet shooting.

4) Firing squad.

5) Throw it in a lake.

6) Feed it to an alligator.

7) Place it on a launchpad and let a rocket launch over the top of it.

8) Mail it to Death Valley.

9) Bury it in cement.

10) (Here's the run it over section) - Run it over with a M-1 Abrams tank.

11) Run it over with a garbage truck with Owen driving.

12) Run it over with my lawnmower.

13) Run it over with skid loader.

14) Run it over with a massive dump truck.

15) Run it over with Komatsu 9xx Series mining truck.

16) Run it over with a space shuttle conveyor

17) Run it over with a golf cart.

18) Run it over with a drag racing car.

19) Tee it up and hit it with a steel driver.

20) Strap it to the front of a demo derby car.

21) Cast it as a lead for a "Saw" movie.

22) Toss it off Mt. Everest.

23) Tape it to the helmet of an NFL linebacker.

24) Drop it from an airplane.

25) Leave it alone with Griffin (he destroyed my otter box)

26) Set it on a batting tee and it hit.

27) Leave it in a Las Vegas back alley.

28) Leave it in a rainstorm (didn't work on my phone - thanks otter box pre-Griffin).

29) Place it on top of the TIV (tornado intercept vehicle).

30) Strategically place it under softball-sized hail.

31) Place it in the path of a wildfire.

32) Skip it across pavement.

33) Throw it against a brick wall.

34) Baseball bats - Office Space Michael Bolton printer style.

35) Toss it from the Omaha pedestrian bridge into the Mighty Missouri (it won't come back!)

36) Strap it to a salmon in the Alaska wilderness.

37) Spray it with a fire house.

38) How could I forget running it over with a Double Drum Asphalt Roller?

39) Take it apart piece by piece.

40) Drop it in a glacier crevasse.

41) Chainsaw it - enough said.

42) Make it sit through the History Research class I took at UNO - great topic, terrible professor.

43) Make it sit through Psych. 101 at UNL - interesting topic, terrible "professor".

44) Make it sit through Philosophy 101 at UNL - ok topic, terrible "professor and GA".

45) Have it watch the movie "Gigli"

46) Have it watch the movie "From Justin to Kelly"

47) Have it watch the movie "Superbabies: Baby Geniuses 2"

48) Have it watch the movie "3 Ninjas: High Noon at Mega Mountain"

49) Set it on train tracks.

50) Place it under a stump grinder

51) Pour poison hemlock all over it.

52) Mail it to an Afghan prison.

53) Read it the Life and Times of FDR.

54) Trash Compactor.

55) Throw it in the sewer.

56) Throw it into the Staypuff Marshmallow Man from Ghostbusters.

57) Bury it in my neighbor's back yard.

58) Leave it in a forest covered in blueberry syrup.

59) Smash it with a boulder.

60) Leave it in the middle of I-80.

61) Skydive it without a 'chute.

62) Strap it to the front of bowling pins.

63) Drill a smily face into it.

64) Make it smell one of Griffin's poopy diapers.  

65) Soak it in the bathtub.

66) Smother it in fish guts and go shark fishing in Ocean.

67) Cover it in cement.

68) Put in in the microwave.

69) Incenerate it with rubbish.

70) Nail gun it to the floor of a roller skating rink.

71) Sliding it through a table saw.

72) Mail it to Aaron Hernandez's house.

73) Flush it down the world's largest toilet.

74) Smother it peanut butter and teach Herbie (our dog) how to play fetch with it.

75) Tuck it into the Mawashi of a sumo wrestler before a match. 

76) Spike it into a lightning rod on top of a skyscraper.

77) Let Ozzy Osbourne bite it during a concert.

78) Slide it into the Gallagher watermelon routine.

79) Stick it in Jell-O and leave it in Dwight's desk.

80) Throw it in a wood chipper.

81) Replacement for the firewood in the chiminea.  

82) Grill it.  Saute it.  Boil It.  Broil It.  Pager Soup.  Pager Gumbo - Bubba Gump style.

83) Stick it inside of Oofy (Owen's stuffed puppy).

84) Dropping it into a body during surgery - of an annoying patient of course.

85) Take it to my boys' daycare.  

86) Toss it into molten lava on a Hawaiian vacation.

87) Drill press.

88) Enter it into the witness protection program.

89) Get it involved in the mafia.

90) Field goal kick practice it with steel toed boots.  

91) Leave it "accidentally" at a construction project.

92) Throw it against a tree - numerous times.

93) Mistakenly drop it in the state fair deep fat fryer I bought my fried Oreos from.

94) Sell it on an infomercial as an antique.

95) Ask an 8th grader to hang on to it for the night and bring it back the next day.

96) Slam it in the car door.

97) Set it on snow skis and aim it at a tree.

98) Test if the Ginsu knife chops plastic.

99) Feed it to a whale.

100) Strap it to a wall and shoot a cannonball at it.

101) Susan's method - Just turn it in to Family Practice because RESIDENCY IS OVER!!!!

MOM.D. Lesson #5

I've learned that I can do it!

The sunrise this morning in case you missed it.  Beautiful!
I take it as a little congratulations gift from God.

Well.  Today is the day.  It's over.  I have my certificate in hand.  I am no longer, for the first time in 24 years, technically a student.  The University of Nebraska has sucked its last dime out of me (although I'm sure I'll be hearing from the alumni association soon, and Jason is already making plans to cut them a check for football season tickets).

It's surreal.  It hasn't really set in yet.  I've been a doctor for three years now, but something about today makes it feel different.  Official.  Susan M. Newman, M.D.  It's been on paper for years now, and it's been on the sign at Grand Island Clinic where I'll be working for a few weeks now.  But, today, I own it.  It's a good day.

Owen, out of the blue this morning at breakfast, asked, "Are you happy, Mom?"

Yes, Owen, I'm really happy!

(In case you didn't believe it.  Here it is.)

MOM.D. Lesson #4

I've learned that being a physician, a mother, just me is humbling.

You may be expecting a tragic story of a patient's terminal illness or miraculous healing, or maybe you're expecting a great teaching moment courtesy of my kids.  While I could probably do both, I, instead, have decided to tell you about my morning - this very morning, just a few moments ago.

It started out no different than any other morning the last week of residency would with a crying, hungry baby and his independent and stubborn brothers.  Jason took them to daycare, and I went off to make rounds at the hospital - probably for the last time as a resident, as long as my patient was ready to be discharged like I was hoping.

I just threw on some clothes, attempted to straighten my bed hair, and put on a smudge of foundation, blush, and mascara.  Presentable, but definitely not CoverGirl material.  I was planning to come home and shower after rounds and before the rest of my day anyway, and my hospitalized patients have bigger things to worry about than how great their doctor looks when I wake them up in a mostly dark room.

As planned, after rounds I came home and poured myself some coffee.  I was headed upstairs to get ready for a second time, when I heard the sound of a garbage truck.  Our boys get overly excited about garbage trucks, and Owen has said on several occasions he is going to be a "garbage truck guy" when he grows up.  But, today, it wasn't just fascination that perked my ears to that sound.  You see, our garbage can has been sitting out in the street for three days now hoping to figure out which day is garbage day at our new house, and today, of all days, I pulled it back to the garage before our new neighbors started to wonder.  Therefore, when I heard that whirring sound of the truck I panicked that I was going to miss it and be stuck with an already full can for another week.

In my socks, I ran out the front door.  Standing in the driveway I looked down the street.  No garbage truck.  No other cans in front of the neighbors.  I guess it turns out that Thursday isn't garbage day either.

Disappointed and relieved at the same time I turned the handle of the front door to go back to my morning.  Click.  Clunk.  The door handle didn't turn.  It was locked.  No big deal, I've been locked out of our other house before and always managed to sneak a way in.  The garage door - locked.  The back door - locked.  Then I scanned the windows and realized they're crank, not sliders.  It wasn't going to be easy to sneak in after all.

The keys were inside.  The garage door opener was inside the Buick which was inside the garage which was shut and locked.  My phone, too, was locked inside.  Everything, including my shoes, were locked safely and securely inside.  Jason won't be home for lunch, and no one else would know to come rescue me.

Now what could I come up with.  One of my staff doctors told me yesterday at my going-away lunch that a license to practice family medicine is a license to practice common sense.  Now, I was in need of some Tom-Cruise-in-Mission-Impossible level common sense.

I rummaged around on the deck, through the boys' toys, and around the yard for something I could use to pick the lock.  I was in luck, there was a metal wire on the front porch that looked like it was created to pick locks - as if I knew what I was doing.

I tried the garage door.  Nothing.  I tried the back door.  Nothing.  I tried smashing the wire with a rock to make it narrow enough to slide in further.  No good.  Remembering there was a code box on the garage to open the door, I thought it was worth a try even though I had no idea what the code would be.  It didn't matter, because it didn't even light up.  The batteries, like my ego, must be dead.

A voice in my head began to speak louder: You're going to have to go get help.  I didn't like that answer because I'm stubborn and prideful.

But, there I stood - socks soaked from the grass, dressed in my work clothes, hair unwashed, and a poor make-up job washing away in the sweat I'd worked up.  I found a pair of Jason's mowing shoes on the front porch to complete the look.  At least they were black to go with my black pants.  I shook the spider out of one (yes, there really was a spider in the left shoe), tied them as tight as you can get shoes that are three sizes too big, and started the 50-yard walk to the elementary school where surely there's a phone.

I walked in, and because of the age we live in, the doors were locked and a buzzer stated it needed to be pressed for entry.  Would they let this scrubby looking, crazy lady in?  Relieved, yet a oddly, as a future parent, a little annoyed, they let this stranger in.

They had a phone, and help was on the way!

A few minutes later, after clearing my flower pots of a few dead blooms to appear as if I had a purpose to be sitting out on the front step, I walked inside.  The lights were on and my coffee was sitting cold on the table as if the house had been wondering where I went.

So, yes, I have some great stories about how being a physician, and how being a mother, is humbling.  But, I think I've had plenty of humbling for one day.

MOM.D. Lesson #3

I've learned that patients will always wake me up in the middle of the night.

Last night was my last night of resident call.  Unfortunately, it wasn't the last time a patient will wake me up in the middle of the night.

I think it's fitting that my last outpatient clinic call was from someone requesting pain medications - which, of course, they didn't get, and which, of course, resulted in some not so nice comments before they hung up.

It's also probably fitting that for my last inpatient admission I couldn't even get a history from the patient because they were so intoxicated.

Yes, I will be taking call at my next job, but with a smaller group of doctors, and with patients of my own who I can coach on when it is appropriate to call, it will hopefully be a little less busy.

As much not fun as it is to wake up to that beep, it's a compromise I'm willing to make.  For now.

*     *     *

I've learned that my children will always wake me up in the middle of the night.

Even on nights that I'm not on call, it is pretty rare to get a "good night's sleep."  All of you other parents (or dog owners) know what I'm talking about.  Someone is constantly crying, thirsty, restless, scared, or angry.

Unfortunately, I don't think this is something they are going to outgrow anytime soon.  Just the thought of three teenage boys all driving at once is enough to keep me awake already.

MOM.D. Lesson #2

I've learned that Every Day I impact the lives of my patients.

(I promise, the lessons aren't all going to be so cheesy, vague, and sentimental.)

My work day is made up of mostly 10 minute appointments with a 20 minute one squeezed in here and there for a mole removal or new patient.  Even in the hospital when I round typically it's about 10 minutes of face-to-face time.  10 minutes is not very long.  It's a jam-packed 600 seconds! 

Over the last several years, my brain has been programmed to take in a lot of quick data to put the puzzle together.  Every little bit of information gets stirred into the pot: why they called for an appointment (e.g. "personal issue" and "STD check" may result in the same evaluation but require a completely different approach), how often they are in (e.g. a cough is probably something different from someone I see once a week than from someone I see once a decade), who else is in the room, the look my nurse gives me after they get checked in, how comfortable they look in the chair when I walk in, etc... and that's just the first 5 seconds.  There's 595 to go. 

You probably had no idea you were under such scrutiny when you go see the doctor.

The reason is that I've learned that this appointment is often what the patient has been planning for, pondering, worried about, hanging their hope on, or dreading for quite some time.  It's not just any 10 minutes to them.

Clearly, they're analyzing me, too.  How confident did I sound when I said it's just a virus?  Did I consider their fear that it could be cancer even though I didn't make eye contact at precisely that moment?  If I don't say something about that 'thing' they are too embarrassed to bring up on their own, does that mean it's nothing to worry about?  Do I look like I don't smoke, exercise, eat well, get shots, sleep enough, and wash my hands like I'm asking them to do?  Was I rushed, or did I sit down?  (FYI: Did you know that studies show that if a doctor sits down when they see a patient in the hospital people feel like they spent more time with them than they actually did?) 

You see, I'm being scrutinized every second, too.  Probably, I should be.

They will leave the office and, for the next several days, tell their spouse, their friends, their boss, their personal journal, and their Bible study their interpretation of everything I've told them and then some.  They may remember my face and my work for years.  Scary.  Humbling.

I'm in a unique position of power and influence when people feel vulnerable and powerless, and I know it.  Making the correct diagnosis and prescribing medicine is only part of what I've spent the past 7 years learning how to do in that little, huge 10 minute visit.

*    *    *

I've learned that Every Day I impact the lives of my children.

I usually only spend about 10 minutes a day with a patient.  Sometimes, it's 10 minutes a year.  But, I spend hours a day and days a month with my kids.  Being aware of how I interact in those brief moments with my patients has made me, also, more aware of how I interact with my boys. 

What is the tone in my voice when I tell them something is dangerous?  Were my eyes on the t.v. or the computer when they said "Mommy, Watch this!"?  Do I eat my vegetables, drink water instead of juice, and wear clean underwear?

The other day we were painting the living room.  I'm, obviously, not very tall, so to get to the point where the wall meets the ceiling I needed a little help.  Out of convenience, I slid a dining room chair across the room, stood on it, and began to paint.  Griffin strolled around the corner and in a firm, 2-year old voice commanded, "Sit dow, Mommy!" just as I have repeatedly said to him.  His little chubby face scrunched into a big, angry frown, and a sticky finger pointed right at me.  Convicted, I apologized, obeyed, and went to get the step ladder.  Still, an hour or so later, there was Griffin pushing a chair across the floor to the wall inches from where it had just been.

They are scrutinizing me, too.  I just can't get away from it!

Obviously, I'm not perfect, and I've made some not so great impacts on patients and on my kids, too.  I realize that's life, and I need to learn from it, apologize, and then move on.

To be complete, learning to be intentional and purposeful is not limited to doctors or mothers either. 
Surely, we can all think of a store clerk, waitress, fellow driver, coach, teacher, friend, or ourselves who made a lasting impact in a matter of minutes or over a lifetime.  We've all been there, and will all be there again.  Scary.  Humbling.  Huh?

MOM.D. Lesson #1

I've learned that I like being a doctor.

After 24 years of continuous education, six figure level of student loan debt (which, by the way, is now under $70,000 - we're almost half way there!), and waiting nearly three decades to start my first "real" job you are probably thinking:  I would hope you actually like it!

Still, after this long, it's not all that difficult to give in to the scars of burnout.  There are a lot of not fun nor glamorous things about this job.  There are sleepless nights.  There are patients who cuss me out on the phone when I don't give them what they want (and usually those are the same people who cause the sleepless night).  There is death and dying.  There is also, obviously, blood, guts, private parts, poo, puke, pain, & suffering, too.  I've talked to more than one currently practicing doctor who said if they knew then what they know now they probably would have chosen a different career.  Honestly, there have been more days than I'd like to admit that I'm in that camp, too.  It's difficult work.  It's physically, emotionally, spiritually, and intellectually exhausting work.  It's work where the heaviness of the responsibility can leave you feeling inadequate and helpless.  And, unfortunately, sometimes I feel like it is becoming unappreciated work.

 

Yet, here I am, on the brink of being unleashed and despite all of that, saying that I really do enjoy my job!

 

The bad moments are offset by moments when new parents want to take a picture of me with their fresh newborn.  There are hugs from patients to help me forget the ungrateful ones.  It is so worth it to help someone end this life gracefully with dignity.  I don't take it for granted that I get to do that, and be a part of that, every day.

 

Yes, I understand there are other careers that are challenging and rewarding.  I know great nurses, stay-at-home moms, ministers, business owners, and students, to name a few who, would deservedly say the same about their line of work.  And, don't forget, I'm married to a middle school teacher if you want to talk about challenging!  But, I don't think anything else on this planet can compare to being a physician - especially a primary care physician.  It's awe-some.

*     *     *

I've learned that I love being a mother.

I chose to be physician.  I planned it and worked hard to get it.  I put in the hours.  I put in the years.  In May, 2010, I was branded with "M.D.," and, hopefully, when everything is official in a few weeks I'll be titled "Board Certified."  It wasn't a whim, and it surely wasn't an accident.

 

Actually, despite what I may have said, becoming a mom wasn't a whim or an accident either.  It never is.  Years ago, I thought I had it planned.  Then we tried.  And then I learned that actually God had it planned instead.  We went over a year with only one line on that stupid pregnancy stick.  Then we gave up, or maybe just gave in.  And then...

 

Then one day, I peed on a stick.  That was all it took.  I was, from that moment on, a "Mommy."  No degree required.  No manual or over-priced textbook.  No plan.  (That's why they were "unplanned.")  I didn't have to take a class, and the test I took wasn't one to pass or fail.  That's it.  Here you go, Susan, here's your son.  Here's your other son.  And, here's another.  I wish you could see the smile on my face right now.  You're a mom.  After being called a lot of things, Dr. Newman included, there is still nothing sweeter to respond to than, "Hey, Mommy."

 

There are a lot of unglamorous things about this position, too.  I still often find myself surrounded with blood, private parts, puke and poo.  It, also, is exhausting.  But again, those moments are far outweighed by the freeze-frame moments with them snuggled in my lap, or sitting by me quietly on the front porch waving at cars, or sprinting down the hall full speed screaming my name and crashing into my knees.

 

Some day, I will probably not be a doctor.  Sure, I may always have the degree or the title.  But some day I'll stop delivering babies, stop taking midnight calls, stop getting up early to make rounds at the hospital, and stop taking appointments at clinic.  I'm totally okay with that, because I hope my legacy isn't just that I was a doctor.  I hope my legacy is that I was Jason's wife and Owen, Griffin, and Jordan's mother.  I will never not be a mom.

 

And I LOVE that.